Frequently Asked Questions for AmeriHealth Caritas New Hampshire Vision Providers

Welcome to the AmeriHealth Caritas New Hampshire Vision Plan

Question: Where can I order frames and lenses?

Answer: AmeriHealth Caritas New Hampshire has partnered with Classic Optical Laboratories, Inc., the preferred vendor of the New Hampshire Department of Health and Human Services (DHHS), for the procurement of frames and lenses.

Question: What about claims prior to August 1, 2024?

Answer: Avesis will accept claims with a date of service (DOS) on or before July 31, 2024.

Question: How often can a member get an eye exam?

Answer: Members are entitled to one refraction eye exam to determine the need for eyeglasses every 12 months. There are no limitations on eye exams necessary for diagnosing and monitoring medical conditions of the eye.

Question: How often can a member get new frames and lenses?

Answer: Members can receive one pair of single vision lenses with frames under the following conditions:

• For members 21 years of age and older, if the refractive error is at least ±0.50 diopter, calculated as a combined total of the spherical and cylindrical errors in both eyes.
• For members younger than 21 years of age, if the refractive error is at least ±0.50 diopter, calculated as a combined total of the spherical and cylindrical errors in at least one eye.

Question: What if a member needs replacement frames or lenses?

Answer: Replacement of eyeglass components due to breakage or damage is subject to the following conditions:

• Replacements may be for a single lens, both lenses, frame only, or a complete pair of corrective lenses.
• Each component or complete pair of corrective lenses can be replaced once within a 12-month period.
• When a member has two pairs of eyeglasses in lieu of bifocals, each pair is eligible for replacement.
• One replacement of lost eyeglasses is provided for members younger than 21 years of age.

Question: How does AmeriHealth Caritas New Hampshire manage hardware and lenses?

Answer: AmeriHealth Caritas New Hampshire has established a statewide agreement with Classic Optical Labs for providers who do not have their own lab or frame options. For providers offering their own hardware services, please note that reimbursement for such items will be limited to the contracted rates. Classic Optical Labs provides a frames kit available for use by any provider. For further details, please contact your Account Executive.

Question: Can members order contact lenses?

Answer: Members can order one set of contact lenses every 12 months, covered up to a maximum of $100. Contact lenses are also provided for ocular pathology in cases where visual acuity is not correctable to 20/70 or better without contact lenses, or when required to correct aphakia or treat corneal disease.